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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2021, Vol. 07 ›› Issue (04) : 227 -231. doi: 10.3877/cma.j.issn.2095-9605.2021.04.002

论著

腹横肌平面阻滞减轻袖状胃切除患者术后急性疼痛及预防术后慢性疼痛
朱俊俊1, 黄春霞1, 胡宪文1,†()   
  1. 1. 230601　合肥，安徽医科大学第二附属医院麻醉科
  • 收稿日期:2021-10-05 出版日期:2021-11-30
  • 通信作者: 胡宪文
  • 基金资助:
    2018年度国家青年科学基金项目(81801050)

Transversus abdominis plane block reduce postoperative acute pain and prevents chronic post-surgical pain after sleeve gastrectomy.

Junjun Zhu1, Chunxia Huang1, Xianwen Hu1,†()   

  1. 1. Department of Anesthesiology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
  • Received:2021-10-05 Published:2021-11-30
  • Corresponding author: Xianwen Hu
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朱俊俊, 黄春霞, 胡宪文. 腹横肌平面阻滞减轻袖状胃切除患者术后急性疼痛及预防术后慢性疼痛[J]. 中华肥胖与代谢病电子杂志, 2021, 07(04): 227-231.

Junjun Zhu, Chunxia Huang, Xianwen Hu. Transversus abdominis plane block reduce postoperative acute pain and prevents chronic post-surgical pain after sleeve gastrectomy.[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 07(04): 227-231.

目的

研究腹横肌平面（TAP）阻滞对减重患者术后急性疼痛、术后慢性疼痛（CPSP）以及术后恢复的作用。

方法

选择2019年11月至2020年11月于安徽医科大学第二附属医院行腹腔镜袖状胃切除术（LSG）的肥胖症患者，按麻醉方法不同随机分为全麻组（GA组）和全麻联合腹横肌平面阻滞组（TAP组），每组各75例。比较两组术后1 h、6 h、12 h、24 h的视觉模拟评分（VAS）、术后48 h内镇痛泵有效按压次数、术后病房补救镇痛发生率、术后恶心、呕吐发生率、术后3 d PSQI评分和术后3、6个月CPSP发生率。其中CPSP数据通过电话随访获取。

结果

与GA组相比，TAP组术后1 h、6 h、12 h、24 h的VAS评分明显降低，术后48 h内镇痛泵有效按压次数及术后病房补救镇痛发生率明显减少，PONV发生率明显降低，术后3 d PSQI评分明显降低（P<0.05）。TAP组术后3、6个月CPSP发生率明显低于GA组（P<0.05）。

结论

TAP阻滞运用于减重手术可以有效地减轻术后急性疼痛，减少阿片类药物用量，改善术后睡眠质量。TAP阻滞可能预防减重患者术后慢性疼痛的发生。

关键词: 腹横肌平面阻滞, 腹腔镜袖状胃切除术, 术后急性疼痛, 术后慢性疼痛, 睡眠障碍
Objective

To study the effect of transversus abdominal plane (TAP) block on acute postoperative pain, chronic post-surgical pain (CPSP) and postoperative recovery of weight loss patients.

Methods

Laparoscopic sleeve gastrectomy was performed in the Second Affiliated Hospital of Anhui Medical University from November 2019 to November 2020. The patients were randomly divided into general anesthesia group (GA group) and general anesthesia combined with transverse abdominal muscle plane block group (TAP group), with 75 cases in each group. The visual analogue Scale (VAS), effective pressure times of analgesia pump within 48 hours after operation, incidence of remedial analgesia in postoperative ward, post-operative nausea and number of vomiting (PONV), Pittsburgh sleep quality index (PSQI) score 3 days after operation and CPSP incidence 3 and 6 months after operation were compared between the two groups. Among them, CPSP data were obtained by telephone follow-up.

Results

Compared with GA group, VAS scores in TAP group decreased significantly at 1, 6, 12, 24 hours after operation, the effective times of analgesia pump and the incidence of remedial analgesia in postoperative ward decreased significantly within 48 hours after operation, and the incidence of PONV decreased significantly after operation. The 3 days after operation PSQI score decreased significantly (P<0.05). The incidence of CPSP in TAP group was significantly lower than that in GA group at 3 and 6 months after operation (P<0.05).

Conclusions

TAP block can effectively reduce postoperative acute pain, reduce the dosage of opioids, improve postoperative sleep quality. TAP block may prevent postoperative chronic pain in patients with weight loss.

Key words: Transversus abdominis plane block, Laparoscopic sleeve gastrectomy, Postoperative acute pain, Chronic post-surgical pain, Sleep disorders
表2 两组患者术后急性疼痛比较
指标 GA组 TAP组 χ2/t值 P值
VSA评分        
术后1 h 2.2±1.2 1.5±1.2 5.1 <0.01
术后6 h 2.0±1.1 1.3±1.0 4.1 <0.01
术后12 h 1.9±0.7 1.3±1.1 3.6 <0.01
术后24 h 1.1±1.1 0.6±1.1 2.9 <0.05
术后48 h 0.3±0.8 0.2±0.8 0.5 >0.05
48 h内镇疼泵有效按压次数（次） 4.2±5.6 2.3±3.1 2.8 <0.05
病房补救镇痛发生率（例/%） 25（33） 12（16） 6.8 <0.01
表1 两组患者一般资料及术中资料比较
指标 GA组 TAP组 χ2/t值 P值
例数 75 75    
性别（男/女，例） 20/55 19/56 0.04 >0.05
年龄（岁） 32.4±7.3 30.4±7.5 1.6 >0.05
BMI（kg/m2） 42.2±6.1 43.3±7.5 1.2 >0.05
ASA I/II级（例） 26/49 22/53 0.5 >0.05
高血压（例/%） 44（58.7） 48（64.0） 0.5 >0.05
高血糖（例/%） 36（48.0） 34（45.3） 0.1 >0.05
高血脂（例/%） 59（78.7） 62（82.7） 0.4 >0.05
手术时长（min） 88.9±20.3 85.2±22.3 1.0 >0.05
术中丙泊酚用量（mg） 427.8±145.2 313.3±118.7 5.3 <0.01
术中瑞芬太尼用量（mg） 1.6±0.6 1.1±0.4 6.4 <0.01
术中右美托咪定用量（μg） 68.1±16.3 67.4±17.5 0.3 >0.05
表3 两组患者术后恢复结果
指标 GA组 TAP组 χ2/t值 P值
术后3 d PSQI评分 6.9±3.0 5.5±2.9 3.1 <0.05
PONV（例/%） 20（34） 10（13） 9.4 <0.05
术后首次下床活动时间（h） 34.5±13.3 33.9±12.4 0.3 >0.05
术后住院时间（d） 3.8±1.4 3.5±0.7 1.9 >0.05
术后慢性疼痛（例/%）        
术后3个月 22（29） 10（13） 5.7 <0.05
术后6个月 15（20） 6（8） 4.5 <0.05
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